WHAT'S UP DOC? Guns: A national health crisis

Tuesday

Nov 13, 2018 at 3:36 PMNov 13, 2018 at 3:36 PM

Q: It seems like there is one mass shooting after another lately. How serious a medical issue is gun violence in the United States?

A: Gun violence is a national health crisis in the U.S. Homicide (two thirds of which involve a firearm) is the 16th leading cause of death in the U.S., and the 3rd leading cause of death in kids 10 to 19 years of age. Gun violence is NOT the only healthcare crisis we are facing, and regular readers of my column know the many different medical issues I have addressed, but today’s column will focus on the medical issues caused by guns.

Although we spend more on healthcare for children than any other country on the planet, our childhood mortality rate is higher than any other wealthy nation, and gun violence is a major driver of this concerning statistic. A teen in the U.S. is over 50 times more likely to be killed by a gunshot than in any other industrialized country. In addition, over 10,000 children under the age of 20 are nonfatally wounded by a firearm (about 16 per 100,000), and overall these injuries are more severe than injuries from other childhood trauma.

Overall, death due to a firearm is very common in the U.S. Firearms took almost 40,000 American lives in 2016; 23,000 from suicide, almost 15,000 from homicide and over 1000 from accidental shootings.

About two thirds of homicides in the U.S. involve firearms (the homicide rate in the U.S. is 5.4 per 100,000 people); compare this to only 4.5 percent of homicides involving firearms in England/Wales (the overall homicide rate there is 1.2 per 100,000 people). With mass shootings defined as a shooting incident where at least 4 people are wounded or killed, one third of all mass shootings in the world since 1966 have occurred in the U.S. even though the U.S. has less than 5 percent of the world’s population.

The almost 400 million guns in the U.S. (more guns than people) make them by far more common than in any other country in the world (Yemen ranks second with less than 60 guns per 100 people). There is at least one firearm in 40 percent of U.S. households with children, and almost 2 million kids live in a house with an unlocked and loaded gun.

There are many things that can immediately be done to address this health crisis:

Require and improve background checks for all gun purchases (over 80 percent of Americans support this).

— This should include aggressively preventing those with serious mental illness from getting access to guns. Motivated in part by the tragedy of the Sandy Hook school shootings, a regulation to have those who are receiving care for serious mental health issues within the Social Security Administration System to be entered into the National Instant Criminal Background Check System was initiated. Unfortunately, President Trump rescinded this regulation shortly after taking office.— States that require background checks and mandatory waiting periods have lower suicide rates than states without these safeguards.— States that restrict access to assault weapons have the lowest per capita homicide rates.
Address the types of guns and ammunition available (such as automatic and semiautomatic weapons, large ammunition capacity guns, armor piercing bullets and other weapons designed for warfare as opposed to personal defense or hunting), and implement other technology improvements (such as fingerprint sensitive high-tech gun locks, loaded chamber indicators, magazine disconnect devices and trigger locks).

Improve education, knowledge and practice of gun safety (over half of all gun-owner households with children do not lock their guns to prevent inappropriate access; nearly all unintentional childhood shooting occur in or around the home). All states require a written and practical test to get a driver’s license, but even requiring a license/permit to own a gun is variable between states.

Improve access to mental health care (this would also have the potential to impact the 70 percent of gun fatalities which are by suicide).

— Cutting back on Medicaid will exacerbate mental health issues by taking away people’s access to healthcare.— A huge number of people in the U.S. who are uninsured are unable to get the mental health care they need, hence cutting back on people who are insured through the Affordable Care Act will also add to the problem.

Increase research to find other ways to address this issue. Research into automobile safety was crucial in driving down the rate of car accident fatalities, but there is a decades-old congressional legislation prohibiting any research that could ‘advocate or promote gun control.’ The March 2018 spending bill that noted that the CDC can research gun violence was a symbolic step forward, but actually allocating funds for this important health issue is what is needed to save lives.

Our politicians continue to send their condolences to the families of people killed in mass shootings, but are unwilling to take actions to actually address the issue. In an effort to improve the safety and health of our population I ask everyone to contact their elected officials and demand they take action.